J Autism Dev Disord (2013) 43:20902098
DOI 10.1007/s10803-012-1756-9
ORIGINAL PAPER
Gender Differences When Parenting Children with Autism
Spectrum Disorders: A Multilevel Modeling Approach
Leah Jones Vasiliki Totsika
Richard P. Hastings Michael A. Petalas
Published online: 10 January 2013
Springer Science+Business Media New York 2013
Abstract Parenting a child with autism may differen-
tially affect mothers and fathers. Existing studies of
motherfather differences often ignore the interdependence
of data within families. We investigated gender differences
within-families using multilevel linear modeling. Mothers
and fathers of children with autism (161 couples) reported
on their own well-being, and their childs functioning.
Mothers reported higher levels of distress compared with
fathers, and child behavior problems predicted psycho-
logical distress for both mothers and fathers. We found
little evidence of child functioning variables affecting
mothers and fathers differently. Gender differences in the
impact of child autism on parents appear to be robust. More
family systems research is required to fully understand
these gender differences and the implications for family
support.
Keywords Autism Spectrum Disorder (ASD)
Mothers

Fathers
Families
Psychological well-being
Multilevel
linear modeling (MLM)
Introduction
Parenting a child with an Autism Spectrum Disorder (ASD)
has been associated with a range of negative outcomes.
Compared to parents of typically developing children,
L. Jones (&)
V. Totsika
R. P. Hastings
M. A. Petalas
School of Psychology, Bangor University, Adeilad Brigantia,
Ffordd Penrallt, Bangor, Gwynedd LL57 2AS, Wales, UK
e-mail: leah.jones@bangor.ac.uk
Present Address:
M. A. Petalas
Mental Health Care, Denbighshire, Wales, UK
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parents of children with an ASD report higher levels of
psychological distress (Eisenhower et al. 2005; Schieve
et al. 2007; Totsika et al. 2011a). Parents of children with
an ASD also report poorer well-being compared to parents
of children with Down syndrome (Dabrowska and Pisula
2010; Eisenhower et al. 2005; Griffith et al. 2010; Olsson
and Hwang 2003), Fragile X syndrome (Abbeduto et al.
2004), cerebral palsy (Eisenhower et al. 2005), and intel-
lectual disability (ID) alone (Blacher and McIntyre 2006;
Totsika et al. 2011b).
Although the majority of research exploring parental
adjustment in the field of ASD highlights negative out-
comes, there is an emerging body of literature reporting on
the positive aspects parents also experience (Bayat 2007;
Griffith et al. 2010; Hastings and Taunt 2002). In fact,
some researchers have shown no differences in positive
perceptions between parents of children with ASD and
other parents once key variables such as child behavior
problems and family socioeconomic position have been
controlled (Totsika et al. 2011a, b).
Family research in the field of ASD traditionally focused
on maternal outcomes alone. However, there is a growing
literature reporting on both maternal and paternal adjust-
ment. Interest in the different impact on all family mem-
bers stems from family systems theory (Seligman and
Darling 1997). These theories emphasize the dynamic and
interdependent nature of the family unit, with the experi-
ences of one member potentially affecting the entire sys-
tem. For example, a number of researchers have concluded
that mothers of children with an ASD experience signifi-
cantly greater levels of stress than fathers (Dabrowska and
Pisula 2010; Herring et al. 2006; Moes et al. 1992; Tehee
et al. 2009). Similarly, mothers have also reported higher
levels of depression (Hastings et al. 2005; Olsson and
Hwang 2001) and anxiety (Hastings 2003; Hastings and
J Autism Dev Disord (2013) 43:20902098
Brown 2002) compared to fathers. In the few studies that
have compared mothers and fathers positive perceptions
of raising a child with an ASD, mothers have reported more
positivity (Hastings et al. 2005; Kayfitz et al. 2010).
Not only does reported well-being apparently differ
between mothers and fathers of children with ASD, but
researchers have also suggested that maternal and paternal
well-being is affected by different variables. Severity of
ASD symptoms and related behavior problems have been
associated with maternal distress (Beck et al. 2004;
Hastings and Johnson 2001; Tobing and Glenwick 2002;
Phetrasuwan and Miles 2009), with fewer such associations
apparent for fathers (Hastings 2003; Hastings et al. 2005).
Similarly, Davis and Carter (2008) reported mothers well-
being to be associated with their childrens self-regulatory
skills, whilst fathers well-being was associated more
strongly with their childrens externalizing behaviors.
Although a general pattern has emerged from existing
research about parental differences in levels of reported
well-being, such findings are not altogether consistent in
that some studies find no mother-father differences (Davis
and Carter 2008; Hastings 2003; Hastings et al. 2005;
Rimmerman et al. 2003). There is also a further analytical
dimension, which makes it difficult to clearly interpret
many of the existing findings. The conventional way to
analyze couple data in ASD family research has been to use
the general linear model (GLM) framework (e.g., t test,
analysis of variance and covariance, and regression anal-
ysis). These models (except for related samples t test)
assume observations to be independent; an assumption
clearly violated within families.
Multiple members within a family form a hierarchical
system of individuals nested within a group. Individuals
from the same family are likely to be more similar to each
other than people from different families because of their
shared environment (i.e., there is likely to be considerable
dependence). Motherfather data can be correctly modeled
as dependent with related samples t tests. However, a
number of researchers attempting to identify correlates of
paternal and maternal psychological well-being have trea-
ted mothers and fathers independentlywith paternal and
maternal well-being treated as separate outcomes in dif-
ferent regression models (e.g., Hastings and Brown 2002;
Hastings et al. 2005; Davis and Carter 2008). When nested
data structures are ignored, the estimates of standard errors
of important parameters may be biased, thus leading to
biased interpretation of the importance of various param-
eters in accounting for the outcome (Moerbeek et al. 2003).
Multilevel linear models (MLM) are an extension of
GLM, where the dependence of nested data is explicitly
addressed.
Some research data focused on mothers and fathers of
individuals with an ASD have been analyzed using MLM,
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primarily in the form of daily diary studies (repeated
measures also equate nested data structures), investigating
parents typical daily experiences and subsequent sub-
jective well-being (Pottie et al. 2009; Pottie and Ingram
2008; Smith et al. 2010). For example, Pottie et al. (2009)
examined contextual factors associated with daily mood in
mothers and fathers of children with ASD over 12 weeks
and found higher levels of child disruptive behaviors sig-
nificantly predicted higher levels of daily negative mood/
psychological distress, with mothers reporting higher levels
of daily negative mood than fathers. Pottie and Ingram
(2008) found that severity of ASD symptomatology was
not predictive of daily positive or negative mood in
mothers or fathers.
In the present study, our aim was to add to the limited
literature exploring motherfather differences in ASD family
research using MLM. Specifically, we were interested in two
questions: (1) Do mothers and fathers report different levels of
positive and negative psychological well-being? (2) Is
maternal and paternal well-being differentially associated
with child characteristics, such as child behavior problems,
severity of autism symptoms and adaptive skills, after con-
trolling for other important factors (e.g., family socioeco-
nomic position)? Directional hypotheses were not proposed
due to inconsistencies in findings from previous research and
methodological limitations in previous research.
Methods
Participants
One hundred and sixty one motherfather couples participated
in the research and were drawn from an ASD family study
focused on sibling well-being (Petalas et al. 2012). The sample
included one adoptive parent couple and one foster parent
couple. The remaining couples were biological parents,
except for nine couples that included a biological mother and
stepfather. The average age of mothers was 41.59 years
(SD = 6.59) and fathers 44.02 years (SD = 5.91). Eighty
(50 %) fathers and 79 (49 %) mothers were educated to uni-
versity degree level or higher, with 99 (62 %) mothers and 152
(94 %) fathers in employment at the time of the research.
Modal household income in the current sample was 25,000
35,000 per year (British pounds sterling; approximately
$40,000$55,000 US dollars).
Families socio-economic position (SEP) was summa-
rized by categorizing families into one of four possible
groups, depending on whether a parent was educated to
university degree level (if so, scoring 1), whether at least
one parent was currently employed (if so, scoring 1) and
whether total annual household income was above the
modal value for the sample of 35,000 (if so, scoring 1).
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Four families (3 %) comprised the lowest possible SEP
group, scoring 0 (neither parent educated to university
level, neither parent in employment, and annual income
below 35,000). Forty nine families (31 %) comprised the
second lowest group, scoring 1 point; 49 families (31 %)
comprised the second highest group, scoring 2 points; and
57 families (35 %) comprised the highest possible group,
scoring 3 points (at least one parent educated to university
degree level or higher, at least one parent in employment,
and total household income above 35,000).
The majority of participants (95 %) described them-
selves as being of White British ethnicity. One hundred and
sixty couples were cohabiting, and the majority of families
(59 %) had two children living in the family home. Ninety-
nine (62 %) of the couples children had a diagnosis of
autism, 61 (38 %) had a diagnosis of Asperger syndrome,
and one child had a diagnosis of Pervasive Developmental
DisorderNot Otherwise Specified. One hundred and thirty
(81 %) children were male and 31 (19 %) female. Children
were on average 10.50 years of age (SD = 2.93), and had
received their ASD diagnosis on average 3.81 years
(SD = 2.70) previously.
Parental Well-Being Measures
The Hospital Anxiety and Depression Scale (HADS;
Zigmond and Snaith 1983) was used to measure parents
mental health. The HADS was constructed to allow a quick
measure of depression and generalized anxiety in hospital
settings, but has been widely used in outpatient and com-
munity research. It has been used successfully to measure
anxiety and depression in parents of children with autism
(Rydebrandt 1991; Hastings 2003). The HADS contains 14
items, with seven assessing depression and seven assessing
anxiety. Respondents rate items such as I feel tense or
wound up and I feel as if I am slowed down on a four (Item 1 does not have a scoring value as it documents whether
point scale: most of the time, a lot of the time, from time to
time, or not at all. Anxiety and depression subscale scores
were used in the current study, with good internal consis-
tency displayed for both mothers (Cronbachs a anxiety:
.85, depression: .83) and fathers (Crobachs a anxiety: .85,
depression: .83).
The Parent and Family Problems Subscale of The
Questionnaire on Resources and Stress-Short Form (QRS-
F; Friedrich et al. 1983) was used to measure general
parenting stress associated with the child with ASD. This
scale contains 20 items, but we removed five items relating
to depression to avoid measurement overlap (Glidden and
Floyd 1997). Respondents rate items, including Our
family agrees on important matters and There is a lot of
anger and resentment in our family, as either true or false.
The QRS-F has previously been used in research with
parents of children with autism, and good reliability was
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J Autism Dev Disord (2013) 43:20902098
obtained (Honey et al. 2005). Internal consistency (Kuder
Richardson coefficient) in the current study was .88 for
mothers and .87 for fathers.
The Positive Gain Scale (PGS; Pit-ten Cate 2003) was used
to measure parental positive perceptions. The PGS is a 7-item
tool, assessing positive experiences related to parenting a
child. Parents perceived benefits of raising the child and gains
made by the family are measured, with respondents choosing
whether they strongly agree, agree, not sure, disagree or
strongly disagree with statements. Sample items include:
Since having this child I feel I have grown as a person and
Since having this child, my family has become more tolerant
and accepting. MacDonald, Hastings and Fitzsimons (2010)
found good internal consistency (Cronbachs a .80) for the
PGS in a population of fathers of children with ID. The PGS
total score was used in the current study (with lower scores
indicating higher levels of positive gain). Internal consistency
(Cronbachs a) in the current study was .84 for fathers and .84
for mothers.
Child Measures
The Social Communication Questionnaire (SCQ; Rutter
et al. 2003) was used to measure the extent of the childs
autism symptoms. The SCQ is an autism-screening instru-
ment, completed by a carer, and based on international
diagnostic criteria (DSM-IV: American Psychiatric Associ-
ation 2000; ICD-10: World Health Organization 2008). The
Current Form of the scale was used for the present research,
assessing the childs behavior and severity of autism symp-
toms over the preceding 3-month period. The SCQ consists
of 40 items, and participants answer yes/no to statements
such as: Is she/he now able to talk using short phrases or
sentences? and Does she/he play any pretend or make-
believe games? A cut-off score of 15 out of a possible 39
or not the child can speak and dictates which of the remaining
items to answer) is recommended as an indicator of a possible
ASD (Rutter et al. 2003). The mean score in the present study
was 20.85 (SD = 7.17), with 133 children (81 %) scoring
above the recommended cut-off. In the present study, pri-
mary caregivers completed the SCQ, and internal consis-
tency (KuderRichardson coefficient) was .83.
The Vineland Adaptive Behavior Scales-2nd Edition
(VABS II; Sparrow et al. 2005) was used to measure the
level of the childs adaptive functioning. The VABS II is
administered as a semi-structured interview, and was
conducted with the childs primary caregiver over the
telephone. The VABS II is composed of items arranged in
developmental sequence that measure adaptive behaviors
across four domains: socialization, communication, daily
living skills, and motor skills (the motor skills domain is
only administered to children below the age of 7). An
J Autism Dev Disord (2013) 43:20902098
overall adaptive behavior composite standardized score
was used in the analyses.
The Strengths and Difficulties Questionnaire (SDQ;
Goodman 1997) was used as a measure of childrens
behavioral and emotional adjustment, completed by pri-
mary caregivers. The 25-item questionnaire measures 4
problem domains: emotional symptoms, conduct problems,
hyperactivity, and peer problems; as well as prosocial
behavior. Respondents rate statements about their child as
not true, somewhat true, or certainly true, based on the
childs behavior over the past 6 months. Example items
from each subscale include: Often unhappy, down-hear-
ted or tearful (emotional symptoms); Generally obedi-
ent, usually does what adults request (conduct problems);
Restless, overactive, cannot stay still for long (hyper-
activity); Rather solitary, tends to play alone (peer
problems); Helpful if someone is hurt, upset or feeling
ill (prosocial behavior). The SDQ is a well-validated
instrument proven to be effective in identifying clinically
significant levels of behavioral disturbance in children
(Goodman 1997). Good levels of reliability have also been
maintained in research with children with autism (Iizuka
et al. 2010). The sum of the four problem domains gen-
erates a total difficulties behavior problem score, which
was used in the present study. Internal consistency (Cron-
bachs a) obtained in the present study for this scale was
.78.
Procedure
The Research Ethics and Governance Committees at
Bangor University and The National Autistic Society
(NAS) approved the broader family study protocol. The
NAS, a UK charity for people with autism and their fam-
ilies, distributed information about the study and invitation
letters to 1,000 families registered on their database. Three
hundred and five families who met the inclusion criteria, of
caring for a child aged 416 years who had a formal
diagnosis of an ASD, returned the invitation letter, and
were mailed consent forms and a questionnaire pack. Two
hundred and fifteen families provided written informed
consent and returned completed questionnaires. Parents
who identified themselves as being the childs primary
carer were then contacted by telephone to complete the
VABS II. The present research focused on 161 families
where a mother and father both participated.
Data Analysis and Results
The data provided by motherfather dyads formed a two-
level hierarchical (multilevel) data structure. Level 1
2093
contains measures at the individual level, representing
variation between individuals. Level 2 contains measures
shared at the family level, representing variation between
families. Level 1 variables in the present research included
parent gender, parent age, and parent outcome measures
(stress, depression, anxiety, and positive gain). Level 2
variables included family SEP, child age, length of time
since receiving diagnosis, family size, child behavior
problems (measured with the SDQ), adaptive behaviors
(VABS), and severity of autism symptoms (measured with
the SCQ).
The MLM framework does not require observations to
be independent, models both fixed and random factors, and
allows cross-level interactions. Fixed factors are variables
where all possible values of interest are measured, and the
average effect in the entire population is expressed by the
regression coefficient. A factor is random if its units can be
regarded as a random sample from a wider population. In
the current study, the family unit was modeled as a random
factor, with all other variables modeled as fixed. When a
multilevel model contains any random effect, a covariance
structure needs to be specified. The covariance structure
establishes the form of the variancecovariance matrix, and
is used to estimate model parameters. For all models in the
present research, an unstructured matrix was chosen, which
makes no assumptions about the magnitude of the corre-
lation between any two pairs of data. The selection of an
unstructured matrix over other alternatives was based on a
lack of prior knowledge about the nature of the covariance
matrix.
Predictor and control variables were centered around
their mean, to add stability to the estimation process and
to ease interpretation (Enders and Tofighi 2007). Mean
centering does not change the parameters, but does aid the
interpretation of the parameters by providing a meaning-
ful value (i.e., the mean) as a reference point for assessing
the magnitude of the parameters (Kraemer and Blasey
2004). Statistical analyses were conducted with PASW
(SPSS) Statistics 18.0. Four multilevel models were
constructed, to examine each of the parental well-being
measures.
First, intercept-only models with no exploratory variables
were fitted (unconditional random effects model), to calculate
the intraclass correlation (ICC). The ICC represents the
within-family and between-family variance. The calculation
of the ICC was used to examine whether within-family cor-
relation was large enough to justify the use of MLM as an
analysis approach. The unconditional random effects model
for each of the four well-being measures suggested that a
significant amount of outcome variance was present within-
families (stress: 46 %, p \ .001; depression: 72 %, p \ .001;
anxiety: 100 %, p \ .001; positive gain: 75 %, p \ .001),
supporting the decision to model the data using MLM.
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The next step in the analysis introduced parent gender as
a fixed effect factor in each model, to address the first
research question: whether mothers and fathers report dif-
ferent levels of positive and negative psychological affect.
At this stage, gender accounted for 18.25 % (p \ .001) of
the variance in stress levels; 5.49 % (p = .002) of variance
in depression levels; 11.40 % (p \ .001) of variance in
anxiety levels; and 6.43 % (p = .001) of variance in levels
of positive gain. Gender was significantly associated with
all outcome measures (father data coded 0, mother data
coded 1), with mothers reporting higher levels of stress,
anxiety, depression, and positive gain (lower positive gain
scale scores represent greater levels of positivity). Table 1
presents mothers and fathers mean scores on well-being
measures, along with the gender coefficients at this stage in
the analyses (Table 1).
Subsequently, potentially significant confounding vari-
ables (age of carer, age of child, family size, time since
receiving ASD diagnosis, and SEP scores) were entered into
the models. Adopting a parsimonious approach for the iden-
tification of important confounders, only control variables
significantly associated with the outcome were retained in the
final models.
In the final step of the analyses, we entered child charac-
teristics (autism symptom severity, behavior problems and
adaptive functioning) in each model. Child predictor variables
(severity of autism symptoms (SCQ total score), level of
behavior problems (SDQ total difficulties score), and adaptive
behaviors (VABS composite standard score), were all entered
into the model to explore their main effects on parental well-
being. In addition, interaction terms between each of these
child variables and parental gender were included. These
interaction terms were included to address our second research
question: whether child characteristics are associated differ-
ently with maternal and paternal well-being.
The results of the final models for each outcome vari-
able are summarized in Table 2. The final model for
parental stress controlled for family SEP (level 2) and child
age (level 2). In the final model, parent gender (level 1) and
Table 1 Maternal and paternal mean scores on outcome measures,
and estimated gender differences
Measure Mothers Fathers Parent gender fixed
effect
Mean SD Mean SD b SE
Stress 10.57 5.19 8.08 5.11 -2.26 .38 \.001
Depression 7.35 3.96 6.11 3.98 -1.19 .37
Anxiety 10.55 4.64 8.02 4.18 -2.46 .49 \.001
Positive 13.81 4.90 15.52 4.66 1.58 .46
perceptions
Gender coefficients displayed are from the second stage of the anal-
yses, when gender was introduced to the models as a fixed effect
child age were significantly associated with parental stress,
with parenting older children related to increased stress.
SEP was no longer significantly associated with stress. As a
main effect, the level of the childs behavior problems
(level 2) significantly predicted stress. However, no other
child variable main effect and none of the interaction terms
(parental gender * child characteristics) were significantly
associated with parental stress. Therefore, the level of the
childs behavior problems increased parental stress overall,
and there was a significant main effect for gender, but there
was no differential relationship between child characteris-
tics and stress depending on parent gender.
The final depression model controlled for family SEP
(level 2). Gender (level 1) and SEP remained significant in
the final model, with lower SEP related to higher levels of
depression. As a main effect, the level of the childs
behavior problems (level 2) was the only variable signifi-
cantly predictive of depression. Overall, the level of the
childs behavior problems was associated with increased
parental depression. None of the interaction terms between
parental gender and child characteristics were significant,
again suggesting that there was no differential relationship
between child characteristics and depression depending on
parent gender.
The final anxiety model controlled for family SEP (level
2). Parents of lower SEP status reported greater levels of
anxiety. As main effects, the level of the childs behavior
problems (level 2) and the level of the childs adaptive
functioning (level 2) were significantly predictive of
parental anxiety. Interaction terms also demonstrated that
the level of the childs behavior problems and adaptive
functioning were differentially associated with parental
anxiety. Mothers anxiety was significantly more affected
by high levels of the child behavior problems. Mothers
anxiety was also more affected by the level of the child
adaptive skills: as adaptive functioning increased, mothers
became more anxious.
The final positive gain model controlled for carer age
(level 1) and length of time since diagnosis (level 2). When
these control variables were introduced, gender was no
longer significantly associated with positive perceptions.
Carer age remained significant, with younger parents
reporting greater levels of positive gain. No child variables
were significantly predictive of positive gain, and there was
no differential relationship between child characteristics
p
and positive gain depending on parents gender.
.002
Discussion
.001
Using an analysis method accounting for the inter-related-
ness of data within families, we found that mothers of
children with an ASD generally reported higher levels of

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Table 2 Final multilevel model results; standardized coefficients of child characteristics on parental well-being and control variables
Variable Stress Depression Anxiety Positive gain
b SE b SE b SE b SE

Intercept 11.50*** 1.16 9.03*** .79 12.81*** .82 14.07*** .43

SEP -.47 .53 -.80* .35 -1.19** .36
Child age .30* .15
Carer age .18** .06
Length since diagnosis -.16 .15
Parent gender -2.07*** .41 -1.39*** .41 -2.31*** .55 .95 .55
SDQ .18* .07 .12* .06 .20** .07 .09 .07
SCQ .14 .08 .08 .06 -.02 .07 -.05 .07
VABS .06 .05 .06 .03 .08** .04 .02 .05
Parent gender 9 SDQ -.10 .70 -.09 .07 -.21* .09 .20 .26
Parent gender 9 SCQ .04 .07 -.01 .07 .02 .09 -.05 .09
Parent gender 9 VABS .004 .04 -.03 .04 -.11* .06 -.003 .06
Following the exploration of confounding variables, each model controlled for the above control variables
Variables not included
* p \ .05; ** p \ .01; *** p \ .001

psychological distress (stress, anxiety, and depression) and
higher levels of positive gain compared to fathers. These
parent gender differences in stress, depression and anxiety
remained statistically significant even after controlling for
demographic characteristics and child characteristics.
Parental differences for positive gain were less robust and
were no longer found once background variables were con-
trolled. We found little evidence of a different pattern of
predictors for paternal and maternal well-being, although
child behavior problems and adaptive behaviors were more
strongly associated with maternal than paternal anxiety.
However, these effects were two from a possible 12 inter-
action effects that could have demonstrated differential
impact for mothers and fathers.
In common with previous research (Lecavalier et al.
2006; Osborne and Reed 2009), we found childrens
behavior problems emerged as a predictor of parental psy-
chological distress (stress, depression, and anxiety). In
contrast, the severity of the childs autism symptoms and
their adaptive skills were not found to be statistically sig-
nificant predictors of parental well-being (with the exception
of adaptive skills predicting parental anxiety). Furthermore,
positive gain was not associated with any child character-
istics, supporting previous findings that parental positivity
may be relatively unaffected by increased behavior prob-
lems/symptomatology and reduced adaptive skills (Hastings
and Taunt 2002).
Mothers are typically more involved in the care of their
children (e.g., Konstantareas and Homatidis 1992), and
therefore have greater potential to be affected by their
childs behavior. In the present sample, 156 (97 %) families
identified the mother as being the childs primary caregiver,
although we included no measure of parenting responsi-
bilities. A qualitative study by Gray (2003) investigating
gender differences when parenting a child with ASD found
that mothers careers were restricted and often sacrificed to
care for the child, and that mothers took on a dispropor-
tionately burdensome role of caring for a disabled child and
coping with the problems that the situation produced
(Gray 2003, p. 641). Mothers also often resented the
inequality in sacrifice and consequent disproportionate
domestic responsibilities. Differing parental responsibilities
may well be a salient contributor towards parental well-
being, and future research is needed to explore the impact
of distribution of responsibilities and sacrifices in explain-
ing parental differences in well-being.
That parental (in particular, maternal) anxiety increased
as childrens adaptive functioning improved may appear
unexpected. Recent findings from other cultures also sug-
gest higher levels of anxiety in mothers of children with
high functioning autism/Asperger syndrome compared to
mothers of children with more severe autism (Mori et al.
2009). Higher functioning children are likely to lead more
independent lives, which could lead to increased parental
anxiety as to their childrens day-to-day safety. Such an
association might also be related to increased levels of
anxiety in children with high functioning autism (Lecava-
lier 2006; Sukhodolsky et al. 2008) that could in turn be
related to increased anxiety in other family members. Such
a pattern of intra-familial psychological distress may be
accounted for by Family Systems theory (Seligman and
Darling 1997), or by shared genetic effects. In relation to

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potential family genetic effects, anxiety levels in biological
mothers of children with autism have been reported to be
higher compared to mothers of other children (Bailey et al.
1998; Micali et al. 2004).
Although paternal and maternal well-being differ sig-
nificantly, the results suggest these differences are due to
factors other than those measured in the current study
(child behavior problems, severity of autism symptoms,
level of adaptive functioning). In terms of variables
explored in previous autism family research, candidate
factors include coping strategies and social support
(Dabrowska and Pisula 2010; Dunn et al. 2001; Lustig
2002). For example, women have been found to engage in
more emotion-focused coping than men (Dabrowska and
Pisula 2010), which could be contributing towards moth-
ers elevated distress profiles. In future research, a broader
range of child, parent, and family variables should be
explored so that the root of gender differences in parental
distress in families of children with ASD can be
elucidated.
It is also important to note that women regularly report
increased depression and anxiety compared to men in the
general adult population (Bekker and van Mens-Verhulst
2007; Kuehner 2003; McLean and Anderson 2009; Van de
Velde et al. 2010). Future research is needed to establish
whether the same variables mediate the impact of potential
stressors on the well-being of women both generally, and
when parenting children with ASD.
The current study had a large sample of 161 mother-
father couples, and the nested structure of the data was
specifically modeled. Despite these methodological
strengths, there are a number of limitations that need to be
considered when interpreting the results. It is questionable
whether the sample is representative of families of children
with an ASD living in the UK. Participants were recruited
through a charitable organizations database, and may
represent families who were actively involved/interested in
the services the charity had to offer. A further limitation is
that primary caregivers (typically mothers) alone com-
pleted measures of the childs autism symptoms and level
of adaptive functioning. Therefore, maternal ratings may
not accurately represent fathers experiences of their
childs behaviors. The current findings need replicating to
add to their validity, and also longitudinal designs are
needed to explore causal links.
Mothers are clearly at greater risk of experiencing
reduced well-being compared to fathers when parenting
children with ASDs. Although further research is needed to
explain why these gender differences are evident, services
need to be aware of potential elevated distress profiles in
mothers, and clinical interventions should target improving
maternal well-being and reducing their psychological
distress.
123
J Autism Dev Disord (2013) 43:20902098
Acknowledgments The preparation of this manuscript was sup-
ported by grant SCS/09/11 from the National Institute for Social Care
and Health Research (Wales) to Bangor University. The original
research was supported by funding from the European Social Fund,
the National Autistic Society, and Bangor University.
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